How did the British socialite Sandra D’Auriol come to jump to her death
from a building in Beverly Hills after a facelift by a top plastic surgeon,
Dr Brian Novack?

Melodrama is the lifeblood of their unembarrassable town, which is packed to the city limits with wealthy and glamorous people behaving outrageously. Yet even the residents of Beverly Hills were shocked to wake up last week to see a lady standing naked atop a 15-storey building for three hours in the morning sun, before meeting a violent end.

“A woman has jumped to her death,” Lisa Vanderpump, a star of The Real Housewives of Beverly Hills whose Villa Blanca restaurant sits opposite on North Camden Drive, announced on Twitter on January 22. “Very sad. Terrible scene.”

The woman was Sandra D’Auriol, a successful British jewellery designer and apparently stable mother of two daughters, who was visiting Los Angeles from Hong Kong to undergo a facelift. Her family have been left mystified by the chaotic activities that consumed her final hours.

“We understand that throughout the psychotic incident the Sandra we knew and loved for her calm, positive disposition never regained consciousness,” they said in a statement. “We draw some comfort from that fact.”

Ms D’Auriol, who was born in India and raised in Singapore and Ibiza, reportedly woke in a frenzy in a 10th-floor room at the Camden Medical Arts building last Wednesday. It is believed she underwent a facelift the previous day at the hands of Brian Novack, an elite surgeon to a string of supermodels and Hollywood actresses said to include Demi Moore and Courtney Cox.

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At about 7am, the 53-year-old, who previously worked for Asprey, the royal jewellers, reportedly became aggressive, tearing at her hair, ripping off her gown and fleeing the recovery room for the roof via the stairs of the building’s top five floors.

As police flocked to the scene and roped off the road below, Ms D’Auriol is said to have walked along the edge of the building as if it were a tight-rope, before sitting down and dangling her legs over the ledge. Nearby, someone was filming with a mobile phone and later uploaded the footage to YouTube.

Her family said they believed a “post-operative neurobehavioural disturbance” was to blame. “Sandra’s daughters feel that awareness of the risks of post-operative psychosis when planning for surgery involving full anaesthesia may help others avoid a similar tragedy,” they said.

Indeed, research published in the European Journal of Plastic Surgery in 2008 concluded that 1.4 per cent of cosmetic surgery patients suffered some form of “post-operative delirium”. Doctors warn that other medications being taken by patients for separate problems can interact with their anaesthesia to disastrous effect if not taken into consideration beforehand.

“In many cases, patients aren’t honest with us,” said Shari Burns, a nurse and the director of Midwestern University’s anaesthesia programme. “It’s private information, and I certainly respect that. But on the other side of the coin, withholding that information can be destructive.”

Ms Burns published research on a 47-year-old facelift patient who reacted aggressively to anaesthesia after failing to disclose she was on other medication. “She was violent, tearing at her clothing, at the bandages, and had to be taken to a hospital for inpatient psychiatric care,” she said.

Ms D’Auriol’s medical situation remains unclear. Almost 10 years ago, however, she suffered the devastating loss of Teo, her 12-year-old son, who drowned in a swimming pool accident during a holiday in Bali, 10 minutes after she had left the pool and returned to their villa to pack.

Recalling how she felt “on the edge of almost insane with sadness”, Ms D’Auriol said in a radio interview obtained by The Telegraph: “I just thought, 'Oh my God, I want to die. I want to go, I want to go.’ That’s how I felt.

“It feels almost every other moment that you are on a precipice of a bottomless pit of such sadness that it’s unbearable,” she said. However she declined anti-depressants because: “I wanted to feel how I felt.”

Yet she had rebounded, carving out a happy life as a popular and successful entrepreneur alongside her French husband Yan D’Auriol, a former L’Oréal executive who runs a cosmetics firm, and two daughters. “Everybody knows her,” said Crystal Kwok, a Hong Kong broadcaster.

She was listed in Hong Kong Tatler’s “500 List” of influential people and won plaudits for her wide range of charitable work. All profits from her jewellery business were reported to “go toward charities focused on children’s, women’s, and environmental causes”.

The spotlight has turned to Dr Novack, 59, who reportedly “looked demolished” after the incident, and is now facing serious questions about his procedures. Having returned to work, he declined to comment on the tragic turn of events.

A spokesman for the Beverly Hills Police Department said: “We are conducting an investigation into the possibility that there may be some criminal negligence involved.” Ed Winter, a senior Los Angeles coroner, said an autopsy had been performed, but the cause of death would not be confirmed until toxicology tests were completed. This may take several more weeks.

Dr John Anastasanos, an eminent plastic surgeon whose office is a few yards from the site of Ms D’Auriol’s fatal jump, said the death had sent shockwaves throughout the industry.

“It’s shocking for so many reasons,” he told The Telegraph. “The big question is: why was she able to take those actions that endangered her life to begin with? Patients should be supervised until they are able to take good and safe care of themselves, but it seems that she really had plenty of time to find access to the roof and put herself in a position of danger.”

The multimillionaire Dr Novack, whose 1970s John Lennon-style long hair and round spectacles set him apart from perma-tanned, bodybuilding colleagues, styles himself as a cut above the usual Hollywood nip-and-tucker. He attended Quebec’s McGill University, a prestigious liberal arts college.

He has been described as the “best plastic surgeon no one will recommend”, because his work is supposedly so good that no one would suspect the patient had even gone under the knife, and is said to have waiting lists of up to five months.

Ms Moore, who denies having had plastic surgery, reportedly paid Dr Novack tens of thousands of dollars for several procedures, including a “knee-lift” to remove sagging skin. Rob Lowe, the actor, named him in a memoir as being among his “treasured friends and confidants”.

“Brian is more of an artist than a surgeon,” Tatiana Namath, his one-time partner, said after leaving her American football star husband for Novack in 1999. “He’s very sensitive.”

He has also been promoting himself by delivering snappy quips in the media for more than 20 years. “Centuries from now,” he told a British interviewer in 1996, “when archaeologists dig up our civilisation, they’ll find dust, bones and implant bags.”

Boasting that he had carried out several procedures on his own mother, he said: “I’ve done liposuction on her back, her inner thighs, her triceps and a little on her abdomen. She’s on her third face-lift.”

Two years ago, Novack even gave a speech – and was photographed with former President Bill Clinton – at a summit in Austria for the Centre for Global Dialogue and Cooperation, which claims to “foster dialogue between business and politics”.

Yet behind this bohemian and waspish exterior lies a ruthless businessman, according to some.

One associate, who spoke on condition of anonymity, claimed Dr Novack was renowned for his imperious bedside manner, and for being one of the most expensive surgeons in Beverly Hills.

“A facelift with Novack can cost up to $150,000 – with other surgeons, $25,000 is the ball park figure,” the source told The Telegraph. “He isn’t one to hold clients’ hands. Some people like his confidence, but he isn’t warm and fuzzy. He is not for everyone, even if they can afford him”.

Remarks from former clients posted to Vitals, a US site where patients review their doctors, support this. “No other doctor had been as rude as Dr Novack,” one apparent client said in June 2011, leaving a one-star grade.

“Dr Novack and his assistant Linda were uncaring and arrogant when the results were bad,” said another last year.

A string of specific complaints were lodged on the site before a notably more upbeat anonymous review appeared just three days after Ms D’Auriol’s death. “Dr Novack was impeccable with his work, and very caring to make sure everything is done very safely and correctly,” it said.

The surgeon to the stars will no doubt be hoping that investigators in Beverly Hills come to the same conclusion.